With Health Care being a major issue right now, I hear people making comments like "the US is moving towards the Swiss model", Or, "The Canadian model is irrelevent, since we're not even considering that model". Well I, for one, am no expert on the various healthcare systems around the world. And if we are to reform healthcare in the US, we should learn from what's been tryed in other countries. This thread will be devoted to presenting the facts about healthcare in various countries around the world and discussing their relative merits. First up, France! It's ranked number one by the WHO, here are the details: France is often seen by liberals as the ideal system. It has universal health care, with few waiting lists. France has the highest level of satisfaction with their health care among all European countries. How can this be? What is their secret? France provides a basic, universal health insurances through large occupation-based funds. The General National Health Inusrance Scheme covers 83% of French workers, while other occupational specific (e.g.: for agricultural workers, for the self employed, for miners, etc.) cover the remainder. About 99% of individuals are covered by this universal health insurance system. However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance. In essence, the French system avoids widespread rationing because, unlike true single-payer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be. Insured. About 99% of French residents are covered by the national health insurance scheme. Cost. France is the third most expensive health care system (~11% of GDP). While the system has generally been well funded, in 2005 the health care system ran a €11.6 billion deficit and in 2006 the health care system had a €10.3 billion deficit. No centrally planned health insurance system will be immune from occasional (or even frequent) deficits. Funding. Most of the funding is from a 13.55% payroll tax (employers pay 12.8%, individuals pay 0.75%). There is a 5.25% general social contribution tax on income as well. Thus, there is an approximately a 18.8% on employees for health insurance. There are also dedicated taxes which are assessed on tobacco, alcohol, and pharmaceutical company revenues. Private Insurance. “More than 92% of French residents have complementary private insurance.” This insurance pays for additional fees in order to access higher quality providers. Private health insurances makes up 12.7% of French health care spending. These complementary private insurance funds are very loosely regulated (less than in the U.S.) and the only stringent requirement is guaranteed renewability. Private insurance benefits are not equally distributed so there is, in essence, a two-tier system. Physician Compensation. French doctors are paid by the national health insurance system based on a centrally planned fee schedule, but doctors can charge whatever price they want. The fees are based on an up front treatment lump sum, which is similar to DRGs in the U.S. The patient–or their private insurance–must make up the difference between the fee charged by the doctor and the amount paid for by the universal health care system. The average French doctor earns only €40,000, although medical school is free for them and the French legal system is fairly tort-averse. Physician Choice. The French have a fair amount of choice in which doctors they choose. However, recently the French have moved towards a more “managed care” practice style where patients have a “preferred doctors” who acts as a gatekeeper for specialists. Copayment/Deductibles. 10% to 40% copayments. Technology. The government does not reimburse new technologies very generously and because of global budgets and fee restrictions, there is little incentive to make capital investments in medical technology. Waiting Times. France has generally avoided waiting lists, likely due to the fairly high coinsurance charges. Recent trends towards Increased restrictions, reduced reimbursement rates, and rationing has increased wait times however. Tanner’s summary. “To sum up: the French health care system clearly works better than most national health care systems. Despite some problems, France has generally avoided the rationing inherent in other systems. However, the program is threatened by increasing costs and may be forced to resort to rationing in the future.”Source So France seems to have a mixed system with the public portion funded by an 19% payroll tax and a few other taxes. It's the third most expensive system in the world spending about 11% of GDP. Via this system, they achieve 99% coverage with minimal waiting times. A 19% payroll tax sounds pretty high to me on top of what we already pay in state and federal taxes. Of course, we already cover the elderly via medicare and the poor via medicaid; so I imagine the tax increase might be less than 19%. I stop here for now and see if anyone else wants to weigh in on healthcare in France.
Starting points We'll take it from an expert, then, to start off: It was the blooper heard round the world. In an editorial denouncing Democratic health reform plans, Investor’s Business Daily tried to frighten its readers by declaring that in Britain, where the government runs health care, the handicapped physicist Stephen Hawking “wouldn’t have a chance,” because the National Health Service would consider his life “essentially worthless.” Professor Hawking, who was born in Britain, has lived there all his life, and has been well cared for by the National Health Service, was not amused. Besides being vile and stupid, however, the editorial was beside the point. Investor’s Business Daily would like you to believe that Obamacare would turn America into Britain — or, rather, a dystopian fantasy version of Britain. The screamers on talk radio and Fox News would have you believe that the plan is to turn America into the Soviet Union. But the truth is that the plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn’t a socialist hellhole the last time I looked. (Krugman) I think this moment, a couple weeks ago, is when people started to get sick of all the Canada- and Britain-bashing by right-wing scaremongers determined not to win, but rather derail any substantial health care debate. So, as you put it, "we should learn from what's been tryed in other countries", or as Krugman says, "Let’s talk about health care around the advanced world". In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs. The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are. Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program. Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies. In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers. So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage. If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort. (ibid) That's the basic outline of the comparisons in the view of a Nobel laureate economist. In order to allay fears of high costs, we're going with a more expensive option. That should tell us something about the state of American politics, if nothing else. There is a seeming problem with the Swiss model insofar as one is required to buy insurance; having worked for insurance companies it's now clear that, while there is certainly effective and proper rhetoric in favor of mandatory auto insurance, the whole thing was a fraud. While we Americans often ridiculed, say, the Soviet way of doing things—approximately three strikes and your license is revoked—we found a way to install a similar system here. Can't get insurance? Can't drive. And while that sounds great as far as keeping bad drivers off the road is concerned, it really does run against the grain of American "freedom". Additionally, because our system was oriented around enhancing corporate revenues, people could be penalized without actually doing anything wrong. Sitting at a traffic light like a good driver, waiting for the signal to turn green? Someone isn't paying attention and slams into you? Guess what? You're a bad driver, so your rates are going up. Is your car legally parked in an available space? Did some drunk careen into it? You weren't even driving, but your rates are going up. In the last couple of years, Allstate and I think at least one other company, have begun promoting "accident forgiveness", in which your rates won't go up for collisions that aren't your fault. In other words, not having your rates jacked for something you didn't do is a reward that you earn. How does that even make sense? Well, if you take that bizarre rhetoric of the left, that we have made economy more important than people, it fits perfectly. With health care, mandatory policies transform the argument; frankly, I would think Republicans would be behind such an argument. They are, after all, the party that has spent much of my lifetime promoting "personal responsibility" and "accountability". And while people argue over whether or not health care is a right instead of a privilege, what we're really doing at the moment is transforming it into a duty incumbent upon all citizens. After all, smokers raise health care costs. So do heavy drinkers. And, if we want to count the beans closely enough, so do bacon, cheeseburgers, milkshakes, Pepsi, Twinkies, butter, eggs ... and so on. What kind of exercise is best? We don't have enough swimming pools to accommodate everyone, and jogging—while I don't object to it as a fitness option—does increase costs over the long run, as does any high-impact exercise. And, hey, playing basketball on macadam? Yikes. Football? Boxing? (Remember, these are also youth programs, not just professional endeavors.) There's no guarantee that we'll go off the deep end—after all, the Brits still play rugby—but we're Americans and have an historical tendency to careen wildly around the center until we trip over it. To what degree the duty of health care transforms our daily lives is yet unseen; let us hope we are wise about it. We're choosing a more expensive option at present in order to preserve the very commercial institutions that have brought the crisis. I'll do some reading over the weekend and see what we can come up with regarding the mechanics of the Swiss system, but I would go so far at this point to assert that the issues I've raised here are far more substantial questions over the long run than the Canadian or British horror propaganda being spread by the right wing, or the incoherent hatred of the Obamanoiac disruptors. In the meantime, across the state in Pullman, over 2,000 students at Washington State University, including most of the football team, as I understand it, are down with swine flu. (You know, swine flu? Remember that one? Sorry, digression.) Let's hope they have good insurance. After all, they're college students, and will emerge from the academic experience with enough debt as it is. ____________________ Notes: Krugman, Paul. "The Swiss Menace". New York Times. August 16, 2009. NYTimes.com. September 5, 2009. http://www.nytimes.com/2009/08/17/opinion/17krugman.html
This one, is technically, about other nation's coverage. So it should be in its own thread. Health care, is the topic du jour and is bound to have a few extras. ~String
You might also notice that I've merged most of the other ones. Let's follow Tiassa's lead and move on to the Swiss: of all the countries with universal health care, Switzerland’s is the most market-oriented and merits discussion. Switzerland’s health care spending as a percentage of GDP is second only behind the U.S. (11.6% of GDP for Switzerland, 15.3% for the U.S. according to Frontline), yet the government pays for very little of this funding. The Swiss system is similar to the “managed competition” health care plan proposed by the Clintons in the early 1990s. Percent Insured. 99.5%. Does this mean a mandated system system would lead to universal coverage in the U.S? This is unlikely. In Switzerland, a mandate for auto insurance has nearly 100% compliance, but in the U.S. the auto insurance mandate’s compliance rate is only around 83%. Funding. Insurance is purchased by individuals. Individuals generally must pay the full cost of premiums, but the government helps to finance insurance purchases for the poor. “These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance,” and one third of Swiss citizens receive this type of subsidy. Thus, the Swiss government only pays for 24.9% of health care costs (compared with 44.7% in the U.S.). Private Insurance. All insurance is private insurance. However, insurance companies are mandated to offer the same “basic benefits package.” Some physicians operate outside the negotiated schedules and individuals are beginning to purchase supplemental insurance to cover the cost of these higher cost physicians. Some estimates claim that 40% of Swiss citizens have purchased supplemental insurance. Physician Compensation. Physician compensation is negotiated between the insurance companies and doctors on a canton by canton basis. Balance-billing is not allowed. Switzerland has strong regulation with respect to nonphysician health care professionals (e.g., nurses, PAs, NPs,) and thus patients are often compelled to use expensive physicians even when this may not be medically necessary. Physician Choice. According to a WHO study, Switzerland ranks second only to the U.S. in terms of the ability of patients to choose their provider. Copayment/Deductibles. Premiums are community rated and only adjusted for sex and age. Employers do not pay for workers insurance and thus many Swiss have opted for less expensive plans with higher deductibles. This has lead to the Swiss paying for 31.5% through out of pocket expenses. Waiting Times. According to a WHO study, Switzerland ranks second only to the U.S. in terms of timely care. Benefits Covered. All insurers cover the “basic benefits package” so most competition between insurers is based on price and service. A politically defined benefit package is susceptible to influence from special interest groups. Thus, Uwe Reinhardt notes that “over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven aspects of the Swiss system.”Source There are many elements of this system that I like. One interesting aspect of the material quoted above is this: Percent Insured. 99.5%. Does this mean a mandated system system would lead to universal coverage in the U.S? This is unlikely. In Switzerland, a mandate for auto insurance has nearly 100% compliance, but in the U.S. the auto insurance mandate’s compliance rate is only around 83%. So, despite insurance coverage being mandatory for all drivers, only about 83% or Americans are insured (verses almost 100% or the Swiss with the same law). Currently, about 85% of Americans have health insurance. Will mandating coverage really increase that percentage? In Massachusettes, a Swiss type statewide system has about 5% remaining uninsured Certainly an improvement over the nationwide figure.
If--and this is a big "if"--the USA ever universalized medicine, I'd opt for the French approach. ~String
Life expectancy from the CIA data base* follows (Longest with 84.36 years is first in the list). Althought the US's rank is lower than these 49 other countries, including Bosnia, the US holds first place in another list. (The cost per citizen.) That should tell even right wing nuts that the US has one of the world's WORST systems. (Probably will not as US education system is not developing many who can rationally think. I.e. those "commercial institutions that have brought the crisis" can easily mislead the ignorant to keep their profits.) Rank country (years) Date of Information (Note the date is always 2009 estimate, but I am too lazy to strip it off the end of the items.) 1 Macau 84.36 2009 est. 2 Andorra 82.51 2009 est. 3 Japan 82.12 2009 est. 4 Singapore 81.98 2009 est. 5 San Marino 81.97 2009 est. 6 Hong Kong 81.86 2009 est. 7 Australia 81.63 2009 est. 8 Canada 81.23 2009 est. 9 France 80.98 2009 est. 10 Sweden 80.86 2009 est. 11 Switzerland 80.85 2009 est. 12 Guernsey 80.77 2009 est. 13 Israel 80.73 2009 est. 14 Iceland 80.67 2009 est. 15 Anguilla 80.65 2009 est. 16 Cayman Islands 80.44 2009 est. 17 Bermuda 80.43 2009 est. 18 New Zealand 80.36 2009 est. 19 Italy 80.20 2009 est. 20 Gibraltar 80.19 2009 est. 21 Monaco 80.09 2009 est. 22 Liechtenstein 80.06 2009 est. 23 Spain 80.05 2009 est. 24 Norway 79.95 2009 est. 25 Jersey 79.75 2009 est. 26 Greece 79.66 2009 est. 27 Austria 79.50 2009 est. 28 Faroe Islands 79.44 2009 est. 29 Malta 79.44 2009 est. 30 Netherlands 79.40 2009 est. 31 Luxembourg 79.33 2009 est. 32 Germany 79.26 2009 est. 33 Belgium 79.22 2009 est. 34 Saint Pierre and Miquelon 79.07 2009 est. 35 Virgin Islands 79.05 2009 est. 36 United Kingdom 79.01 2009 est. 37 Finland 78.97 2009 est. 38 Jordan 78.87 2009 est. 39 Isle of Man 78.82 2009 est. 40 Korea, South 78.72 2009 est. 41 European Union 78.67 2009 est. 42 Puerto Rico 78.53 2009 est. 43 Bosnia and Herzegovina 78.50 2009 est. 44 Saint Helena 78.44 2009 est. 45 Cyprus 78.33 2009 est. 46 Denmark 78.30 2009 est. 47 Ireland 78.24 2009 est. 48 Portugal 78.21 2009 est. 49 Wallis and Futuna 78.20 2009 est. ----------------------- *https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
Yeah I don't get it, the French system sounds ideal. If it collapses that means the whole nation collapsed.
It delivers an 80.98 year life expectancy - Ranks 9th in the world and most of the higher ones are oriental nations that tend to have healthier diets (More protein from fish, less from beef, and few over eat to be fat. Pork is used mainly to add flavor to stir-fried dishes*, not as ham & pork chops, etc.) Average French person lives 2.87 years longer than an American and pays less for medical care. ----------------- *Cooked with light oil, little use of butter or other fats that are solid at room temperature. Modest amounts of light oil are good for health.
If the cons, neo-cons, and theocons can bring themselves to consider the commonweal over selfishness.
What are theocons? Also, I think the Singaporean system is the most efficient of any developed economy. http://econlog.econlib.org/archives/2008/01/singapores_heal.html http://en.wikipedia.org/wiki/Health_care_in_Singapore http://healthcare-economist.com/2008/01/14/singapores-health-care-system/
IIRC in some thread recently one of our Canadians posted a link to a graph comparing various nations' health care cost per capita, broken down by public (tax) and private. And what struck me was how much the US taxpayer is shelling out right now for the US system - before having to buy private insurance. The US is paying about as much in taxes per capita to buy medical care as the French are. The French medical care tax bill is about the same, per capita, as the US. Meanwhile, one key component of the Swiss mandated purchase setup is that corporation profiting from health insurance is a felony level crime, and no insurance corporation may screen mandated coverage applicants for risk ("pre-existing conditions" are irrelevant for basic coverage).
Pre-WSJ quote below, Billy T comments: Living conditions in rural China are rapidly improving. The CCP is trying to slow migration to the coastal cities. Major land reform laws (allowing owners to lease their tiny plots to others so larger efficient farming is possible) are part of the reason, but China is building many (nearly a hundred new, one-million-plus, urban centers) modern cities in the interior; however, heath service have only gone from “non-existent” (traditional herbal medicines) to “poor.” E.g.: WSJ: “…QUNGUANG, China -- Here in China's agricultural heartland, signs of progress abound. Qunguang village's 1,000 inhabitants, who live among rolling fields of corn, rice and peanuts, are linked to the world by a new 215-mile, $1.6 billion expressway. An industrial park is under construction nearby. Incomes for rural people in the county jumped 85% between 2000 and 2008. At the local health clinic, not far from the highway exit ramp, Mei Ruying diagnoses patients with little more than a stethoscope and a thermometer. To keep abreast of new drugs, Ms. Mei, who lacks a medical degree, reads instructions enclosed in the boxes. China's rickety health-care system relies on thousands of practitioners like Ms. Mei. Often, they are poorly compensated and ill-equipped to serve their big rural constituencies. According to the national health ministry, just 17% of China's medical workers in 2005 were university graduates. In village clinics and township hospitals, just 2% were. … This year, the government announced a plan to spend more than $120 billion on the first phase of a 10-year overhaul of the health-care system. By 2020, China says, it wants all its citizens to have access to affordable, basic medical services. … A central goal of Beijing is to improve the affordability and availability of care in China's less well-off rural areas, which are home to more than half the population. To do that, the government has launched a crash construction program for county hospitals and township clinics. ... The government has been ratcheting up the insurance coverage available to farmers through county-level rural-cooperative insurance plans. The programs, which began in 2003, now cover roughly 90% of rural people, according to the health ministry. Chinese health-care reform could also play a role in making the economy less reliant on exports by stimulating domestic demand. The specter of high medical costs -- and the lack of a social-security system -- is a major force driving Chinese to save rather than spend. Please Register or Log in to view the hidden image! Note first two are for Rural only. Third bar graph is national. Whether China succeeds in the task has implications for global public health. China is the world's most-populous nation, with 1.3 billion people. And diseases that emerge here -- such as severe acute respiratory syndrome -- quickly spread around the world. …” From: http://online.wsj.com/article/SB125556557369186287.html?mod=article-outset-box Billy T comment: I think that the USA has a greater percentage of its citizens without any health insurance than China does now. Chinese health care is less sophisticated than that available to richer Americans. This is part of why less than 7% of Chinese income is spent on health care (third graph above). Another reason is no-doubt that the rural population (> half the total) still use local herbs and animal parts, etc. instead of troubling to go to the more modern services now being provided.
The French model appears to be quite similar to the structure of Medicare, a national health care system for seniors that has been functioning for over 40 years.
